Dr. Austin O'Carroll:

I thank Senator Fitzpatrick. In terms of PEAs, there are some very good ones, but rather than comment on whether we should have PEAs or STAs, I think we need to ensure there is a proper standard of care provided and that includes wraparound services and health services. That is the key element that I am recommending. On Housing First, we still need to focus on getting people out of homelessness. I agree with the Senator that we need to address that issue and that the services need to be all on a par. We cannot have one service that is less than another. I agree on that point.

I agree also with the Senator's remarks in regard to trauma informed care. I will give an example of that care by way of a story I often tell. I had two clients who had been homeless for five years and addicted to several substances who ended up in the casualty department in a hospital due to hypothermia. The guy was losing consciousness. As the doctor and nurse were cutting of his clothes the doctor turned to his partner and said "this is disgusting the condition you've got yourselves into" and made them feel so bad that when they left, they swore they would not go back to hospital unless they were dying. I do not blame that doctor because he or she is in a system where there is stigma and as he or she is probably overworked and over-stressed the stigma gets concentrated. Those two patients went to a different doctor in a mobile health unit run by Safetynet and staffed by a GP trainee who helped them to see Dr. Clíona Ní Cheallaigh, who referred them to us. They are no longer in addiction and the woman has qualified this year for one of the top universities in Ireland. This shows that with a proper response and someone who understands what people have gone through can lead to a totally different path. Again, I do not blame that doctor. We need to train everybody how to interact people through trauma informed care. I agree with Senator Fitzpatrick that this care should provided through all of the social welfare offices and health services. It could also be taught in schools as well. We need to teach the teachers.